Inadvertent intrapleural placement of a thoracic epidural catheter identified during robotic-assisted video-assisted thoracoscopic surgery (VATS).

Abstract

Thoracic epidural analgesia is widely considered the gold standard for perioperative pain control in thoracic surgery. Despite its benefits, placement is technically challenging and can result in rare complications such as catheter misplacement into the intrapleural space. This case report will discuss a female patient in her late 70s with scoliosis and obesity who underwent robotic-assisted video-assisted thoracoscopic surgery for a pulmonary mass. The thoracic epidural catheter placed preoperatively was later directly visualized in the intrapleural space during the procedure. The catheter was immediately removed with no complications. Thoracic epidural placement can be challenging due to patient factors, such as positioning, age, body habitus, and spinal deformities, as well as the inherent anatomy of the thoracic spine.Inadvertent intrapleural catheter misplacement is likely an under-reported complication that can lead to pneumothorax, hemothorax, and inadequate pain control; however, some catheters left in place have successfully been used for analgesia.